Italy fights vaccines fear

This is the last story in a POLITICO special report on vaccines: the accomplishments, history, controversy and business challenges.

The Italian health minister had a message for parents who might not think their children need to be vaccinated.

“My twins are three months old and I vaccinated them this morning: Moms do not be afraid; vaccines save lives,” Beatrice Lorenzin, told reporters on her way out of the local hospital, from where she live-streamed the first vaccination of her newborn children last year.

The move is the latest attempt by Italy’s health institutions to encourage parents to vaccinate their children. Misinformation, highly organized campaigners and two court cases siding with claims that vaccines lead to autism have spurred a dramatic drop in vaccinations in the last decade.

“The Italian situation is unique. Italy has been called out by the WHO [World Health Organization] because the vaccine coverage of the country is falling,” said Lorenzo Moja, an Italian public health expert with the global health body, adding that in some regions, about one in five children do not complete the recommended vaccination schedule.

This phenomenon began about 10 years ago and has worsened recently, he said.

Data from the Italian National Health Institute confirm the trend. While overall coverage is 94.7 percent, data from January shows that between 2013 and 2014 coverage for the second dose of the vaccine for measles-mumps-rubella – known as MMR – dropped from 83 to 82 percent in all Italian regions.

To bridge the gap, the health ministry last year launched a €700 million National Vaccination Plan which, after months of delay in a bureaucratic logjam, is finally expected to kick off this month.

“We have strong alliance with the industry and we also have a pact with schools who will have to verify if their students are vaccinated,” Raniero Guerra, director general of the health prevention at the health ministry, said in an interview. “We also reached an agreement with the order of physicians, who will be paying close attention to those doctors that discourage parents from vaccinating their kids.”

Monitoring these anti-vaccine doctors is key to encourage parents to vaccinate their children. It is also necessary to rebalance the responsibility from parents to state authorities, he said.

“Among doctors working in hospitals, the vaccination rate is very low, and the communication in favor of vaccines is even lower,” said Giovanni Rezza, director of research with the National Health Institute.

The anti-vaccine campaigners

But the vaccination plan will not solve the country’s biggest problem: anti-vaccine campaigners. One of the oldest and largest of such groups in Italy is the Coordination of the Italian Movement for the Freedom of Vaccinations, or COMILVA, founded in 1993.

The organization devotes a section of its website to “damages provoked by vaccines,” with another dedicated to what they call the link between vaccination and autism. “Vaccines cause swelling, inflammation of the brain, encephalitis or better to say autism,” the section says.

Despite scientific consensus that no such link is proven, they say absence of proof that that there is not an association is good enough.

“There are so far no studies out there that exclude 100 percent the scientific link between autism and vaccines,” Claudio Simion, the group’s president said. They want obligatory vaccinations to be postponed until children are two years old, instead of two months old.

To counter this push-back, AIFA, Italy’s agency in charge of drug pricing and reimbursement, launched a campaign against anti-vaccine propaganda.

“Despite the assurances of health authorities on the safety and effectiveness of vaccines, there has been an unjustified and troubling resistance of some parents to vaccinate their children. The resistance is largely due to the anti-vaccine campaigns that rage on the web and in magazines and books of questionable scientific value,” the agency said in its campaign.

Anti-vaccine advocates were encouraged by two court rulings in their favor in recent years.

In 2012, a lower Italian court ruled for parents of a child diagnosed with autism a year after receiving an MMR vaccine.The court relied on the now retracted and disputed work of former British surgeon Andrew Wakefield, who published in the British journal the Lancet in 1998 findings from a study of 12 people purporting to show a link between the MMR vaccine and autism.

In addition to being retracted by the medical journal, an investigation found Wakefield falsified facts and failed to disclose he got funding from lawyers working for parents suing vaccine drugmakers.

In 2015, a court of appeals overturned the Italian decision, accepting the appeal filed by the health ministry. The expert appointed by the court of appeals highlighted the absence of scientific evidence supporting an MMR-autism link. The expert highlighted that the lower court case had relied on Wakefield’s retracted studies.

But in a separate case in 2014, a court in Milan ordered the health ministry to pay a life long reimbursement to another autistic child.

The minister of health spoke out generally and reaffirmed the lack of scientific evidence to sustain the claim that there is a correlation between autism and vaccines.

The health ministry’s Guerra said the rulings have not helped matters.

“The court cases have sent a message of incoherence on behalf of the government to parents, who saw one side the ministry of health, encouraging them to vaccinate their children and on the other the judiciary ruling that these same vaccines could give their kids autism,” Guerra said.